{"id":924,"date":"2013-06-12T11:18:41","date_gmt":"2013-06-12T09:18:41","guid":{"rendered":"http:\/\/slanedeti.sk\/cms\/traviaca-sustava-a-jej-najcastejsie-postihnutia-pri-cf-2\/201306"},"modified":"2014-04-07T16:18:34","modified_gmt":"2014-04-07T15:18:34","slug":"traviaca-sustava-a-jej-najcastejsie-postihnutia-pri-cf-2","status":"publish","type":"post","link":"https:\/\/slanedeti.sk\/cms\/traviaca-sustava-a-jej-najcastejsie-postihnutia-pri-cf-2\/924","title":{"rendered":"Tr\u00e1viaca s\u00fastava a jej naj\u010dastej\u0161ie postihnutia pri CF"},"content":{"rendered":"

Druhou naj\u010dastej\u0161ou pr\u00ed\u010dinou morbidity a mortality pri cystickej fibr\u00f3ze, po bronchopulmon\u00e1lnom ochoren\u00ed, s\u00fa patologick\u00e9 procesy tr\u00e1viaceho syst\u00e9mu. Porucha funkcie CFTR sp\u00f4sobuje ochorenia pankreasu, pe\u010dene a gastrointestin\u00e1lneho traktu (pa\u017eer\u00e1k, \u017eal\u00fadok, \u010drev\u00e1).<\/p>\n

Pankreas a jeho postihnutia
\n<\/strong><\/h5>\n

Postihnutie exokrinnej funkcie pankreasu a malnutr\u00edcia.<\/p>\n

Exokrinnou<\/strong> (vonkaj\u0161ou) sekr\u00e9ciou pankreasu rozumieme vytv\u00e1ranie enz\u00fdmov, ktor\u00e9 sa podie\u013eaj\u00fa na rozkladan\u00ed cukrov, tukov a bielkov\u00edn na jednoduch\u0161ie l\u00e1tky, ktor\u00e9 potom m\u00f4\u017eu by\u0165 vstreban\u00e9 sliznicou tenk\u00e9ho \u010dreva do organizmu.<\/p>\n

Malabsorpcia<\/strong> \u2013 je naj\u010daste\u0161iou poruchou pri pankreatickej insuficiencii (nedostato\u010dnosti) a sp\u00f4sobuje ju ob\u0161trukcia kan\u00e1likov, strata acin\u00e1rnych buniek a deficit pankreatick\u00fdch enz\u00fdmov. Pre t\u00fato poruchu s\u00fa typick\u00e9 objemn\u00e9, p\u00e1chnuce stolice, ktor\u00e9 sa daj\u00fa len \u0165a\u017eko spl\u00e1chnu\u0165. Ak nie je t\u00e1to pankreatick\u00e1 nedostato\u010dnos\u0165 v\u010das lie\u010den\u00e1, vedie k neprospievaniu, chudnutiu a spomaleniu a\u017e k z\u00e1stave rastu. Diagnostikuje sa zobrazovac\u00edmi met\u00f3dami (ultrazvuk, CT vy\u0161etrenie, ERCP, magnetick\u00e1 rezonancia) laborat\u00f3rnym vy\u0161etren\u00edm stolice a tie\u017e monitorovan\u00edm nutri\u010dn\u00e9ho stavu pacienta, ktor\u00fd spo\u010d\u00edva v pravidelnom sledovan\u00ed telesnej hmotnosti, telesnej v\u00fd\u0161ky a pr\u00edpadn\u00fdch antropometrick\u00fdch meraniach, \u010falej meran\u00edm hladiny vitam\u00ednu D, bielkov\u00edn, tukov, esenci\u00e1lnych mastn\u00fdch kysel\u00edn v krvi a \u010diasto\u010dne m\u00f4\u017ee by\u0165 nutri\u010dn\u00fd stav hodnoten\u00fd aj denzitometrick\u00fdm vy\u0161etren\u00edm.<\/p>\n

Malnutr\u00edcia<\/strong> \u2013 je podv\u00fd\u017eiva. Prejavuje sa nedostato\u010dn\u00fdm energetick\u00fdm pr\u00edjmom, zv\u00fd\u0161en\u00fdmi stratami, ale aj zv\u00fd\u0161enou spotrebou. Lie\u010di sa pod\u00e1van\u00edm pankreatick\u00fdch enz\u00fdmov, zv\u00fd\u0161en\u00edm energetick\u00e9ho pr\u00edjmu na 120-150% oproti zdrav\u00fdm \u013eu\u010fom, pr\u00edjmom vitam\u00ednov rozpustn\u00fdch v tukoch (ADEK), esenci\u00e1lnych mastn\u00fdch kysel\u00edn a antioxidantov.<\/p>\n

Pankreatit\u00edda<\/strong> – z\u00e1pal pankreasu b\u00fdva aj prvou manifest\u00e1ciou CF. Recidivuj\u00faca pankreatit\u00edda m\u00f4\u017ee by\u0165 jedin\u00fdm prejavom CF.<\/p>\n

 <\/p>\n

Postihnutie endokrinnej funkcie pankreasu sp\u00f4sobuje<\/strong><\/h5>\n

Diabetes mellitus<\/strong> (CFRDM) – de\u0161trukcia pankreasu m\u00f4\u017ee u chor\u00fdch s CF sp\u00f4sobi\u0165 endokrinn\u00fa (vn\u00fatorn\u00fa) \u2013 hormon\u00e1lnu pankreatick\u00fa nedostato\u010dnos\u0165 a to hlavne v dospelom veku. Naj\u010dastej\u0161ie sa prejavuje ako porucha tvorby a vylu\u010dovania inzul\u00ednu. K prvotn\u00fdm pr\u00edznakom patr\u00ed \u00fanava, chudnutie \u010dast\u00e9 mo\u010denie, sm\u00e4d. Promptne zah\u00e1jen\u00e1 lie\u010dba pod\u00e1van\u00edm inzul\u00ednu b\u00fdva efekt\u00edvna a m\u00e1 pozit\u00edvny vplyv na celkov\u00fd priebeh ochorenia.<\/p>\n

\"travenie\"<\/div>\n
Hepatobili\u00e1rne postihnutia pri CF<\/strong><\/h5>\n

Cirh\u00f3za pe\u010dene – ide o ochorenie, ktor\u00e9 postihuje pe\u010de\u0148ov\u00e9 tkanivo a cievne rie\u010di\u0161te pe\u010dene. Trp\u00ed \u0148ou asi 5% pacientov s CF. Diagnostikuje sa laborat\u00f3rnymi vy\u0161etreniami (ALT, AST,GMT, CHS, Quik), zobrazovac\u00edmi met\u00f3dami (ultrazvuk, Dopplerovsk\u00e1 sonografia, CT, MRCP). Z invaz\u00edvnych vy\u0161etrovac\u00edch met\u00f3d je to biopsia pe\u010dene. Lie\u010di sa pod\u00e1van\u00edm kyseliny ursodeoxycholovej (UDCA). V z\u00e1va\u017en\u00fdch pr\u00edpadoch po splnen\u00ed ur\u010dit\u00fdch krit\u00e9ri\u00ed je mo\u017en\u00e1 transplant\u00e1cia.<\/p>\n

Port\u00e1lna hypertenzia<\/strong> – je klasick\u00e1 komplik\u00e1cia pri cirh\u00f3ze, ktor\u00fa mo\u017eno definova\u0165 ako zv\u00fd\u0161en\u00fd tlak v port\u00e1lnej \u017eile. U cirhotika d\u00f4jde k situ\u00e1cii, \u017ee krv pe\u010de\u0148ou pretek\u00e1 pomaly a preto sa za\u010dne hromadi\u0165 v port\u00e1lnej \u017eile. Najz\u00e1va\u017enej\u0161ou komplik\u00e1ciou port\u00e1lnej hypertenzie je krv\u00e1canie z pa\u017eer\u00e1kov\u00fdch varixov, pri ktorom m\u00f4\u017ee hrozi\u0165 vykrv\u00e1canie. Diagnosticky aj terapeuticky je pri port\u00e1lnej hypertenzii \u00faspe\u0161n\u00e1 gastrofibroskopia. Lie\u010dba m\u00f4\u017ee by\u0165 konzervat\u00edvna, ktor\u00e1 spo\u010d\u00edva v pod\u00e1van\u00ed antihypertenz\u00edv (najm\u00e4 neselekt\u00edvnych betablok\u00e1torov) a invaz\u00edvna (napr. endoskopick\u00e1 sklerotiz\u00e1cia, podviazanie varixov…)<\/p>\n

Ochorenia \u017el\u010dn\u00edka<\/strong> patria tie\u017e k mimope\u010de\u0148ov\u00fdm ochoreniam hepatobil\u00ed\u00e1rneho syst\u00e9mu. U pacientov CF sa vyskytuje nefuk\u010dn\u00fd \u017el\u010dn\u00edk, nepriechodnos\u0165 alebo z\u00fa\u017eenie \u017el\u010dovodu, \u017el\u010dov\u00e9 kamene.<\/p>\n

 <\/p>\n

Postihnutia gastrointestin\u00e1lneho syst\u00e9mu<\/strong><\/h5>\n

Pa\u017eer\u00e1k<\/strong> \u2013 naj\u010dastej\u0161ou komplik\u00e1ciou je gastroezofage\u00e1lny reflux, ktor\u00fd vznik\u00e1 nedostato\u010dnou \u010dinnos\u0165ou pa\u017eer\u00e1kov\u00e9ho zviera\u010da, \u010do sp\u00f4sobuje vracanie \u017eal\u00fado\u010dn\u00e9ho obsahu do pa\u017eer\u00e1ka a vyvol\u00e1va p\u00e1lenie a ezofagit\u00edda (z\u00e1pal pa\u017eer\u00e1ka).<\/p>\n

\u017dal\u00fadok<\/strong> \u2013 zv\u00fd\u0161en\u00e1 sekr\u00e9cia \u017eal\u00fado\u010dnej \u0161\u0165avy a n\u00edzky obsah bikarbon\u00e1tu v pankreatickej \u0161\u0165ave m\u00f4\u017ee sp\u00f4sobi\u0165 \u017eal\u00fado\u010dn\u00e9 vredy. \u010cast\u00e1 b\u00fdva aj gastrit\u00edda – z\u00e1pal \u017eal\u00fado\u010dnej sliznice, ktor\u00fa m\u00f4\u017ee sp\u00f4sobi\u0165 aj agres\u00edvna medik\u00e1cia.<\/p>\n

 <\/p>\n

Ochorenia \u010driev<\/strong><\/h5>\n

Mek\u00f3niov\u00fd ileus<\/strong> – je prv\u00fd prejav ochorenia det\u00ed s CF. M\u00e9k\u00f3nium (smolka) je prv\u00fd \u010drevn\u00fd obsah die\u0165a\u0165a po p\u00f4rode, ktor\u00fd je abnorm\u00e1lne hust\u00fd, v\u00e4zk\u00fd a pru\u017en\u00fd a sp\u00f4sobuje ob\u0161trukciu v dolnej \u010dasti tenk\u00e9ho \u010dreva (ileu), \u010do m\u00f4\u017ee vies\u0165 k zauzlenie \u010driev, a\u017e k ich odumretiu, pretrhnutiu a z\u00e1palu pobru\u0161nice. Naj\u010dastej\u0161ie sa odstra\u0148uje klyzmou.<\/p>\n

DIOS<\/strong> – (dist\u00e1lny intestin\u00e1lny ob\u0161truk\u010dn\u00fd syndrom) je ekvivalent mek\u00f3niov\u00e9ho ileu v neskor\u0161om veku a vyskytuje sa asi u 3 % pacientov CF. Pri DIOS doch\u00e1dza k ob\u0161trukcii dolnej \u010dasti tenk\u00e9ho \u010dreva visk\u00f3znym muk\u00f3znym a fek\u00e1lnym obsahom, postihuj\u00facim aj slep\u00e9 a hrub\u00e9 \u010drevo. M\u00f4\u017ee vznikn\u00fa\u0165 nedostatkom tekut\u00edn, zmenou stravy alebo nedostato\u010dnou pankreatickou substit\u00faciou. Diagnostikuje sa RTG brucha, irigografick\u00fdm vy\u0161etren\u00edm, ktor\u00e9 je z\u00e1rove\u0148 aj lie\u010dbou. V pr\u00edpade ne\u00faspechu sa rie\u0161i chirurgicky.<\/p>\n

Prolaps rekta<\/strong> – m\u00f4\u017ee sa sta\u0165, \u017ee pri tla\u010den\u00ed stolice vyjde von mal\u00e1 \u010das\u0165 hrub\u00e9ho \u010dreva. Vyskytuje sa ve\u013emi vz\u00e1cne a to u nelie\u010den\u00fdch mal\u00fdch det\u00ed. Preva\u017ene sa lie\u010di konzervat\u00edvne.<\/p>\n

Crohnova choroba<\/strong> – ide o ochorenie, pri ktorom m\u00e1 \u010dlovek chronicky zap\u00e1len\u00fa niektor\u00fa \u010das\u0165 tr\u00e1viacej s\u00fastavy, naj\u010dastej\u0161ie tenk\u00e9 alebo hrub\u00e9 \u010drevo. Pacient trp\u00ed \u010dast\u00fdmi boles\u0165ami brucha, hna\u010dkami a nafukovan\u00edm. Diagnostikuje sa vy\u0161etren\u00edm krvi a kolonoskopiou. Lie\u010dba m\u00f4\u017ee by\u0165 medikament\u00f3zna, v z\u00e1va\u017en\u00fdch pr\u00edpadoch sa rie\u0161i chirurgicky.<\/p>\n

Respira\u010dn\u00e9 ochorenia a ich lie\u010dba si vy\u017eaduj\u00fa zv\u00fd\u0161en\u00fd energetick\u00fd v\u00fddaj, ktor\u00fd m\u00f4\u017ee zabezpe\u010di\u0165 iba dobre funguj\u00faci tr\u00e1viaci syst\u00e9m a to je d\u00f4vod, pre ktor\u00fd je potrebn\u00e9 lie\u010di\u0165 ka\u017ed\u00fa jeho poruchu, dodr\u017eiava\u0165 pokyny lek\u00e1rov a spr\u00e1vnu v\u00fd\u017eivu.<\/p>\n

Zdroj: \u010derpan\u00e9 z odbornej pr\u00e1ce MUDr. Branislava Remi\u0161a, Klinika pneumol\u00f3gie a ftizeol\u00f3gie I. SZU, Univerzitn\u00e1 nemocnica Bratislava<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

Druhou najčastejšou príčinou morbidity a mortality pri cystickej fibróze, po bronchopulmonálnom ochorení, sú patologické procesy tráviaceho systému. Porucha funkcie CFTR spôsobuje ochorenia pankreasu, pečene a gastrointestinálneho traktu (pažerák, žalúdok, črevá). Pankreas a jeho postihnutia Postihnutie exokrinnej funkcie pankreasu a malnutrícia. … Continued<\/a><\/p>\n","protected":false},"author":6,"featured_media":1044,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"kt_blocks_editor_width":"","footnotes":""},"categories":[253],"tags":[235],"class_list":["post-924","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-o-cystickej-fibroze","tag-traviaca-sustava"],"yoast_head":"\nTr\u00e1viaca s\u00fastava a jej naj\u010dastej\u0161ie postihnutia pri CF - Slan\u00e9 deti<\/title>\n<meta name=\"description\" content=\"Porucha funkcie CFTR sp\u00f4sobuje ochorenia pankreasu, pe\u010dene a gastrointestin\u00e1lneho traktu (pa\u017eer\u00e1k, \u017eal\u00fadok, \u010drev\u00e1).\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/slanedeti.sk\/cms\/traviaca-sustava-a-jej-najcastejsie-postihnutia-pri-cf-2\/924\" \/>\n<meta property=\"og:locale\" content=\"sk_SK\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Tr\u00e1viaca s\u00fastava a jej naj\u010dastej\u0161ie postihnutia pri CF - 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